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Oxford Handbook of Acute Medicine

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The Oxford Handbook of Acute Medicine is the essential guide to the management of the acutely ill patient. It features expanded material on practical procedures and new information on common presentations.
... Intercostals paralysis gives rise to difficulty in swallowing and impaired respira on which may be life threatening and needs endo-tracheal intuba on and ar ficial ven la on. Of late demyelina on, 'Channelopathies' 3 have also been iden fied. Because of lower motor involvement paralysis is preceded by paresthesia in the distal part of the extremi es. ...
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Introduction: Guillain Barre Syndrome in pregnant ladies, undergoing cesarean section, has not yet reported in Nepal. Anaesthetic management of 15 patients with Guillain Barre Syndrome who underwent lower segment cesarean section at Nobel Medical College Teaching Hospital is reported here. Objective: The purpose of this study is to assess the benefits of Rectus sheath nerve block along with infiltration of retropubic space of Retzius in Guillain Barre syndrome patients planned for lower segment cesarean section (LSCS). Methodology: During the period from 1st August 2015 to 31st April 2020 at NMCTH, a retrospective descriptive analysis of 15 pregnant ladies with Guillain Barre Syndrome who underwent lower segment cesarean section under Rectus sheath nerve block along with Retro pubic space of Retzius, infiltration and visceral peritoneum infiltration is discussed. Result: Considering Surgeons opinion about the operating conditions like Relaxation, Straining, Coughing, Bucking, Satisfactory to good operative conditions were reported. Excellent to good satisfaction was expressed by 39.9% of patients, 60% patients reported satisfactory. Hypotension and Arrhythmias was seen in 2 patients. Diaphoresis was seen in 1 patient. Fetomaternal outcome was good. There was no mortality. Conclusion: Rectus sheath block along with infiltration of retro pubic space of Retzius block can be considered as a good alternative to general anaesthesia or neuraxial block incase where general anesthesia & neuraxial block is risky or contraindicated for lower segment cesarean section in patients with Guillain Barre Syndrome.
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There is a myriad of changes that can be produced in the eye by toxic drugs ranging from mild/no symptoms to severe loss of vision from endophthalmitis. The routes of administration include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces. It is important to recognize certain clinical signs and symptoms in the eye produced by these toxins. This article describes in brief some of the ocular effects of commonly abused drugs. For identification of a particular poisoning, in addition to the clinical presentation, pulse, blood pressure, respiration and body temperature, pupillary size, pupillary reaction to light, ocular convergence and nystagmus can be useful indicators of the type of drug the patient is exposed to. Unmasking these features help the clinician in an early and accurate diagnosis of the offending drug as well as timely management.
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Problem drinking is a significant public health concern in the UK and is receiving growing media attention. While the headlines often focus on the harm of teenage ?binge drinking?, the more subtle and far reaching psychosocial implications of chronic alcohol misuse can often be overlooked. GPs are well placed to recognize and manage the diverse health complications of alcohol misuse. Evidence suggests that even minimal brief interventions can have a significant positive impact on individuals who drink to excess. This article discusses some of the medical and psychosocial complications of both acute and chronic alcohol use that GPs should be aware of in order to assess and reduce the harm caused by alcohol within the primary care setting.
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Endocrine emergencies are rare in general practice but it is important that GPs know the key aspects of diagnosis and management which may be life saving. Diabetic emergencies are the most common and can present acutely and unexpectedly. Disorders of the hypothalamic pituitary axis are much less frequent so can be harder to diagnose. It is vital for a GP to recognize the key signs of endocrine disorders, initiate appropriate management and arrange timely referral.
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